Deregulation in immune regulatory components has been proposed in its pathogenesis.

What does this study add?

Deficiency in regulatory T cells (Tregs), altered expression of Treg-associated parameters and increased percentage of programmed cell death 1-positive Tregs in active GV were the main findings of the study.

Clinical correlation was also established. Major defects in immune regulatory components were identified during the first episode of disease attack.

Current treatments for vitiligo and chronic wounds are often not very effective and unsatisfying for patients.

Conventional epidermal blister grafting is one treatment option for chronic vitiligo, but is time consuming, limited to small areas and requires surgical skill.

What does this study add?

Novel fractional epidermal micrografting is a promising alternative treatment for vitiligo and chronic wounds with fewer side-effects to donor and receptor sites and has the advantage of treating larger lesions.

Further up in the hierarchical system, several mediators regulate TSLP expression. Tumour necrosis factor (TNF)-α occupies a prominent position among these mediators when applied exogenously; however, the in vivo relevance of TNF-α is barely defined.

What does this study add?

TSLP is rapidly induced upon physicochemical irritation in murine skin in vivo and enters the circulatory system.

Endogenous TNF-α is not involved in skin TSLP production under a multitude of conditions in murine skin, and this seems to apply to an even greater extent in human skin.

Interleukin-1 partially mediates this irritation-induced TSLP expression. This effect is more prominent in human skin, which displays significant differences in TSLP regulation compared with murine skin.

Sporotrichosis is a worldwide granulomatous disease caused by several Sporothrix spp., commonly acquired by local trauma with contaminated organic material or via contact with diseased animals, especially cats.

Special forms of sporotrichosis have been described mainly in zoonotic epidemics ongoing in South and Southeast Brazil and it could be related to differences in frequencies among Sporothrix spp. as well as types of transmissions involving sapronosis or zoonosis.

Therefore, molecular identification may be helpful to guide treatment and for epidemiological purposes. In addition, serology may support clinical decisions.

Chronic hand eczema (CHE) is a common skin disease with a high socioeconomic impact.

While some light has been shed on genetic factors that predispose individuals to the disease, little is known about its actual pathogenesis.

Several recent findings indicate that CHE develops as a consequence of an impaired epidermal barrier.

What does this study add?

We aimed to carry out a systematic and comprehensive analysis of the differential protein expression in CHE using state-of-the-art mass spectrometry.

We performed liquid chromatography with tandem mass spectrometry analyses and label-free quantification to analyse the proteomic profile of palmar skin from patients with hand eczema and healthy volunteers.

To our knowledge, this is the first study to employ this approach. The results of our study demonstrate that skin-barrier dysfunction plays an essential role in the pathogenesis of CHE.

The manifestation of inflammatory skin disease is altered and typically diminished following nerve damage.

What does this study add?

We suggest that sensory neurons are necessary contributors to inflammatory skin disease and that neural blockade may serve as a primary or adjunctive approach to the treatment of certain inflammatory diseases.

Although there are reports in the literature on the economic burden of psoriasis, few studies have compared differences in health care services use between patients with psoriasis and those without it.

Only one study has previously reported that patients with psoriasis incur greater health care costs than a general group of patients.

What does this study add?

With regard to both dermatology and nondermatology services, patients with psoriasis had significantly more outpatient visits, and greater outpatient and total costs than those without it.

The total cost for all health services was about 1·4-fold greater for patients with psoriasis than those without it.

Total-body naevus counts and dysplastic naevi are important risk factors for melanoma.

Naevi with distinct dermoscopic patterns differ in size, anatomical and age distribution, and host pigmentation characteristics.

What does this study add?

We have identified associations between genetic variants and the number of naevi in early age.

We have identified associations between host genetics and the dermoscopic pattern of naevi, supporting the hypothesis that naevi distinguished by their dermoscopic pattern represent distinct biological subsets.

Some case reports concerning the concomitant presence of congenital melanocytic naevi (CMN), halo naevi and vitiligo have been published. However, their possible link has never been investigated in a large patient population.

What does this study add?

This study provides evidence that CMN may influence the age of onset of vitiligo and trigger the development of halo naevi in patients with vitiligo.

Patient survival and the proportion of thin cutaneous malignant melanoma (CMM) has been rising over time in most Western countries, although the corresponding rate of improvement of survival appears to have declined in Sweden at the end of the last millennium.

What does this study add?

Swedish nationwide time trends of tumour thickness in CMM have been analysed for the first time.

A shift over time towards thinner CMMs for men was accompanied by a 19% improved 5-year CMM-specific survival.

Corresponding changes were not observed for women, although a superior 5-year CMM-specific survival still exists compared with that of men, motivating a continued need for improved secondary preventive actions for men.

Vitamin D can be obtained from the diet or through oral supplementation, or synthesized in human skin following exposure to ultraviolet radiation (UVR).

Many authorities advocate that UVR exposure is essential for adequate vitamin D levels; however, UVR exposure can lead to skin cancer development, resulting in approximately 13 million skin cancers worldwide per annum.

What does this study add?

This study demonstrates that many healthy adults in different populations across the world can maintain adequate serum vitamin D levels despite negligible UVR exposure for several months of the year.

Public health campaigns promoting a high vitamin D diet or supplements to healthy adults could positively impact the burden to the individual and the health service of inadequate vitamin D levels and could avoid the negative sequelae of UVR exposure.

Over the last 50 years there has been an epidemic of atopic disease and associated allergy, the environmental causes of which have not been established.

What does this study add?

The physiological T helper (Th) 2 cell skewing of pregnancy and early life, and how accentuation of this Th2 skewing is associated with development of atopic disease and allergy is reviewed and highlighted.

We postulate that certain types of exposures to chemicals can accentuate this Th2 skewing.

We postulate an alternative explanation, which is independent of the hygiene hypothesis, for the inverse association between birth order and atopic allergy.

Pulsed-dye laser (PDL) was one of the first widespread treatments for port-wine stain (PWS). Significant advances in the technique of PDL and its efficacy and safety for treating PWS have been demonstrated in previous studies.

Vbeam® and Cynergy® are both 595-nm PDL systems that have been widely used to treat PWS lesions. No prior study has compared the efficacy of the two pieces of equipment.

What does this study add?

This is the first prospective side-by-side comparison study of 595-nm PDL devices.

Our results suggest that Vbeam may have higher efficacy in the treatment of PWS than Cynergy. Despite using supposedly equivalent fluences in 595-nm PDLs, equivalent clinical results cannot be guaranteed.

Review Articles

Onychomadesis is characterized by separation of the nail plate from the matrix with persistent attachment to the nail bed and often but not always, eventual shedding. Onychomadesis has been associated with infection, autoimmune disease, critical illness, and medications.

What does this study add?

To our knowledge a literature review of all associations with onychomadesis has not been completed previously.

The number of patients on antithrombotic medications undergoing cutaneous surgery is steadily increasing.

There are no strict guidelines on perioperative management of these agents and the data on bleeding complications is contradictory.

What does this study add?

This study provides an up-to-date comprehensive approach to the management of antithrombotic medications in patients undergoing cutaneous surgery.

The available data on warfarin, aspirin and clopidogrel is sufficient to recommend that these medications be continued throughout cutaneous surgical procedures.

The risk of bleeding complications in patients on antithrombotic medications can be minimized by meticulous surgical techniques, elaborate haemostasis, pressure dressings and close postoperative follow-up.

Forward somatic mosaicism in EB has only been demonstrated for a KRT5 mutation in EB simplex. Parental germline mosaicism was reported for a LAMB3 mutation in Herlitz junctional EB and a dominant COL7A1 mutation in dystrophic EB (DEB).

Forward somatic mosaicism exceeding the germ cells has not been reported in DEB.

What does this study add?

We report on forward somatic mosaicism for the COL7A1 mutation p.Gly2034Arg in the unaffected mother of a patient with DDEB pruriginosa.

This highlights that forward mosaicism occurs in DEB, which has important implications for genetic counselling in sporadic cases.

Our results narrow down the amount of mutant pro-α1(VII) procollagen that is tolerated by the skin to ≥ 10–25% (i.e. 20–50% mutant keratinocytes).

However, so far there have been no sufficiently powered randomized controlled trials (RCTs) in the literature analysing the efficacy and safety of these devices.

What does this study add?

To the best of our knowledge, this is the first RCT that analyses the 595-nm PDL in the treatment of superficial BCC at uncritical anatomical sites (trunk and extremities) with a follow-up of 6 months.

Clinical and dermoscopic features of unusual variants of Spitz naevi have been reported only rarely.

What does this study add?

We describe clinical, dermoscopic and histopathological features of uncommon morphological variants of Spitz naevi, in order to raise awareness among clinicians about their peculiar patterns of presentation.

There are regional variations in the scalp hair miniaturization seen in androgenetic alopecia (AGA).

Use of topical minoxidil can lead to reversal of miniaturization in the vertex scalp.

What does this study add?

Frontal scalp of patients with AGA is responsive to minoxidil treatment in a manner similar to vertex scalp.

The hair-growth properties of minoxidil topical foam may be mediated through increased production of hair keratin-associated proteins and decreased epidermal differentiation complex and inflammatory gene expression.